For many, living with bipolar disorder also means experiencing debilitating migraine attacks.

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Experiencing a migraine attack on top of bipolar disorder symptoms can feel like a double whammy.

For people who live with bipolar disorder, migraine is quite common. At its worst, migraine can cause everything from vomiting to unbearable pain and light sensitivity. For many people, migraine attacks are debilitating for 1 to 4 days.

Bipolar disorder is a condition of mood episodes and energy shifts that can negatively impact how you function day by day. Episodes of depressive symptoms can flip to states of high energy and agitation known as mania or hypomania.

If you experience both, it can be helpful to learn about the link between the two conditions and how to put together a treatment strategy with your doctor to get the most relief.

There’s no evidence that suggests bipolar disorder causes migraine, but the two conditions are commonly seen together.

Having both conditions often makes episodes of both more frequent. Migraine tends to develop after the onset of bipolar disorder.

As many as 29% of people living with bipolar disorder have experienced migraine. That’s a significant difference compared to 12% of the general population who have migraine.

The relationship between the two conditions seems to go both ways. In a 1990 study, people with migraine were three times as likely to have a bipolar spectrum disorder.

Migraine is also associated with an earlier onset of bipolar disorder and more severe and frequent depressive episodes.

A history of childhood abuse increases the likelihood of co-occurrence (comorbidity) of bipolar disorder and migraine, according to the same study.

Migraine is more common in women, as is the comorbidity of bipolar disorder and migraine.

Are headaches a symptom of bipolar disorder?

Headaches are not listed as part of the diagnostic criteria for bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

There are several reasons you might experience a headache or migraine attack — some harmless and others more concerning.

You might be dehydrated or have experienced eyestrain, for example. On the other end of the spectrum, you may be experiencing brain injury or chronic illness.

Living with migraine doesn’t mean you’re living with bipolar disorder.

Many people live with migraine and never experience a co-occurring mental health condition. In fact, many migraine episodes occur without any evidence of mental or physical illness.

While still not a symptom of any type of bipolar disorder, migraine is much more prevalent in bipolar II disorder than in bipolar I disorder. In a small 2001 study, 82% of participants with bipolar II disorder had migraine, compared to 27% of people with bipolar I disorder.

So, what are the symptoms of bipolar disorder?

Several main types of bipolar disorder exist, all defined by mood and energy shifts, including:

  • Bipolar I disorder: Episodes of elevated mood and agitation known as mania that can be severe enough to require hospitalization. Depressive episodes may also occur but are not required for diagnosis.
  • Bipolar II disorder: Patterns of depressive episodes and states of moderately elevated mood known as hypomania.
  • Cyclothymia: Milder symptoms of both hypomania and depression that last for a period of at least 2 years.

Experts believe bipolar disorder and migraine share a number of underlying mechanisms.

These overlapping causative factors may include chemical imbalances, the presence of chronic inflammation, and imbalance in nitrosative stress management.

Chronic inflammation can both initiate and increase pain. Researchers are particularly interested in studying inflammatory cytokines as a common factor in bipolar disorder in migraine.

Mitochondrial dysfunction, or issues with how the body’s cells produce energy, and genetic and environmental factors, like childhood abuse, may also be at play.

What other mental health conditions are associated with migraine?

Migraine is associated with a handful of other mental health disorders, including:

Migraine is also more commonly seen among people who’ve experienced a form of abuse, live with sleep disturbances or disorders, and experience high levels of stress.

Migraine has high comorbidity with other inflammatory and pain conditions including fibromyalgia, psoriasis, and asthma.

The exact causes underlying bipolar disorder aren’t well understood. The same can be said about migraine.

This means treating them simultaneously can be challenging, and there are no current best-practice methods for comorbid treatment.

Research suggests a few overlapping treatment options work for both migraine attacks and bipolar disorder, including medications:

  • valproate
  • lithium
  • lamotrigine
  • quetiapine
  • topiramate

And therapies:

If you live with bipolar disorder and experience a migraine attack, there are ways you may be able to manage the headache without compromising your bipolar disorder treatment course.

When working on a treatment plan, medication interactions have to be taken into account, as well as the type of migraine you’re experiencing. You and your doctor can work together to closely monitor any side effects that medication for one condition is having on the other.

Finding the right treatment balance may take patience but it has the potential to significantly improve your quality of life.

There are several holistic ways to manage a migraine attack when it comes on.

Stress relief

Research suggests stress is one of the most commonly self-reported triggers of migraine attacks. Navigating life’s stressors with bipolar disorder may mean your stress burden is unrelenting.

Managing stress proactively — as well as in the moment — may help limit the effects of migraine. Some calming exercises include:

  • yoga
  • meditation
  • journaling
  • tai chi
  • exercising

Escape the light

During a migraine episode, it’s common to experience photophobia, a heightened sensitivity to light. When you feel a migraine attack coming on, lying down in a dark, quiet place can help soothe the pain.

Blue wavelength light, used in electronics, tends to be the most painful during a migraine attack. Blue-light-blocking glasses may help you decrease the impact of electronics if you’re unable to step away from screens while your headache resolves.

Hot soaks

A hot bath may offer a way to manage migraine pain without competing with bipolar disorder treatment.

Participants in a 2016 migraine study were asked to conduct a hot arm and foot bath alongside an ice massage to the head daily for 45 days. The hot bath was found to help reduce the intensity of a headache, as well as the frequency of occurrence.

Bipolar disorder doesn’t cause migraine, and migraine doesn’t cause bipolar disorder. Due to overlapping mechanisms in the body, many people live with both.

Both conditions can significantly impact your quality of life. Together, they can make finding an effective treatment a bit trickier.

While you may be able to treat some symptoms of both conditions with the same medication, relief may require individualized approaches. But there are ways to manage migraine pain without compromising your bipolar disorder treatment.

If you’re experiencing untreated migraine attacks during bipolar disorder therapy, speaking with your healthcare team may open up options for dual relief.